Book: Review/Commentary: School-Based Drug Prevention: What Kind of Drug Use Does it Prevent?

Abstract

School-Based Drug Prevention: What Kind of Drug Use Does It Prevent? by Jonathan P. Caulkins, Rosalie Liccardo Pacula, Susan Paddock, and James Chiesa (Santa Monica, CA: RAND, 2002), 174 pp., $24 (paper).The authors of School-Based Drug Prevention propose two primary research questions: Are school-based prevention programs cost effective? If so, what are the most appropriate sources of funding for the implementation and maintenance of these programs?To answer the first question, the authors utilized data on the effects of school-based prevention exposure from seven drugprevention programs with demonstrated success. These programs produced significant reductions in the use of tobacco, alcohol and marijuana through high school and of cocaine use after high school. While these reductions decay over time, there is strong evidence that delaying the experimentation with or use of these substances until the early adult years will reduce the probability of ever using these substances or of increasing their use to a problematic level. Delaying the use of tobacco, alcohol and marijuana during adolescence also reduces the probability of later involvement with other illicit drugs such as cocaine or heroin.To determine if effects demonstrated by these programs show reductions in use that outweigh the costs of their implementation, the authors developed a simple conceptual model: social costs averted per prevention program participant. Estimates of the social costs averted through exposure to prevention programming are obtained by multiplying several factors: amount of each of the substances consumed in an average person's lifetime, the percentage reduction in lifetime use of each substance as a result of participation in prevention programs, and the social cost per unit of each substance consumed in grams resulting in an estimate of social cost as dollars per gram. The authors use data from the National Household Survey on Drug Abuse to develop trajectories of lifetime use of alcohol, tobacco, marijuana and cocaine and the projected reductions in use for individuals exposed to effective adolescent prevention programming. Their calculations include an overall projected estimate of prevention benefits based on an estimated consumption of each substance for those who initiate use; a social-benefit adjustment to reflect the additional reduction in use resulting from the contagion effect of individuals electing not to use alcohol or drugs; and a market multiplier that measures the projected decrease in availability and consequent increase in cost of drugs that results from reduction in overall use.Once made, these calculations are adjusted using several discount factors. The first is the delay in benefits accrued, as it is assumed that it takes a lifetime to realize the long-term objectives of the prevention program. An additional reduction is taken for the effects of scaling up the program to the national level and the consequent reduction of program effectiveness. Finally, the correlation coefficient between early initiation and later initiation is included to account for the inability to perfectly predict future substance use based on use during the adolescent years. Although the authors' estimates are rough because of the level of analysis and their reliance on secondary data sources for their analyses, they are able to compensate by offering two estimates-one very conservative, the other very liberal-for each factor, and the average of the two is used for the basis of their conclusions. The final calculations indicate that while prevention programs cost approximately $150 per student to implement, their per-person lifetime social benefit is valued at about $300, indicating that successful prevention programs are in fact cost effective.Findings from these analyses are used to address the second research question. The authors argue that the greatest savings would be obtained from decreases in the use of tobacco (accounting for about 40% of the value of prevention) and of alcohol (accounting for over 25%). …